tbuckley/cabot-search huggingface dataset:
Cardiac Magnetic Resonance Imaging Versus Computed Tomography to Guide Transcatheter Aortic Valve Replacement: A Randomized, Open-Label, Noninferiority Trial
Authors: Martin Reindl, Ivan Lechner, Magdalena Holzknecht, Christina Tiller, Priscilla Fink, Fritz Oberhollenzer, Sebastian von der Emde, Mathias Pamminger, Felix Troger, Christian Kremser, Elisabeth Laßnig, Kathrin Danninger, Ronald K. Binder, Hanno Ulmer, Christoph Brenner, Gert Klug, Axel Bauer, Bernhard Metzler, Agnes Mayr, Sebastian J. Reinstadler
Journal: Circulation (2023)

Computed tomography (CT) is recommended for guiding transcatheter aortic valve replacement (TAVR). However, a sizable proportion of TAVR candidates have chronic kidney disease, in whom the use of iodinated contrast media is a limitation. Cardiac magnetic resonance imaging (CMR) is a promising alternative, but randomized data comparing the effectiveness of CMR-guided versus CT-guided TAVR are lacking.An investigator-initiated, prospective, randomized, open-label, noninferiority trial was conducted at 2 Austrian heart centers. Patients evaluated for TAVR according to the inclusion criteria (severe symptomatic aortic stenosis) and exclusion criteria (contraindication to CMR, CT, or TAVR, a life expectancy <1 year, or chronic kidney disease level 4 or 5) were randomized (1:1) to undergo CMR or CT guiding. The primary outcome was defined according to the Valve Academic Research Consortium-2 definition of implantation success at discharge, including absence of procedural mortality, correct positioning of a single prosthetic valve, and proper prosthetic valve performance. Noninferiority was assessed using a hybrid modified intention-to-treat/per-protocol approach on the basis of an absolute risk difference margin of 9%.Between September 11, 2017, and December 16, 2022, 380 candidates for TAVR were randomized to CMR-guided (191 patients) or CT-guided (189 patients) TAVR planning. Of these, 138 patients (72.3%) in the CMR-guided group and 129 patients (68.3%) in the CT-guided group eventually underwent TAVR (modified intention-to-treat cohort). Of these 267, 19 patients had protocol deviations, resulting in a per-protocol cohort of 248 patients (121 CMR-guided, 127 CT-guided). In the modified intention-to-treat cohort, implantation success was achieved in 129 patients (93.5%) in the CMR group and in 117 patients (90.7%) in the CT group (between-group difference, 2.8% [90% CI, -2.7% to 8.2%]; P<0.01 for noninferiority). In the per-protocol cohort (n=248), the between-group difference was 2.0% (90% CI, -3.8% to 7.8%; P<0.01 for noninferiority).CMR-guided TAVR was noninferior to CT-guided TAVR in terms of device implantation success. CMR can therefore be considered as an alternative for TAVR planning.URL: https://www.gov; Unique identifier: NCT03831087.
Underutilization of Mineralocorticoid Antagonists in Patients With Heart Failure With Reduced Ejection Fraction
Authors: Shingo Matsumoto, Toru Kondo, Pardeep S. Jhund, Ross T. Campbell, Karl Swedberg, Dirk J. van Veldhuisen, Stuart J. Pocock, Bertram Pitt, Faiez Zannad, John J.V. McMurray
Journal: Journal of the American College of Cardiology (2023)
The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action
Authors: Eloi Marijon, Kumar Narayanan, Karen Smith, Sérgio Barra, Cristina Basso, Marieke T Blom, Lia Crotti, Andre D'Avila, Rajat Deo, Florence Dumas, Anastase Dzudie, Audrey Farrugia, Kaitlyn Greeley, Gerhard Hindricks, Wei Hua, Jodie Ingles, Taku Iwami, Juhani Junttila, Rudolph W Koster, Jean-Benoît Le Polain De Waroux, Theresa M Olasveengen, Marcus E H Ong, Michael Papadakis, Comilla Sasson, Sang Do Shin, Hung-Fat Tse, Zian Tseng, Christian Van Der Werf, Fredrik Folke, Christine M Albert, Bo Gregers Winkel
Journal: The Lancet (2023)
Research advances of nanomaterials for the acceleration of fracture healing
Authors: Mo Zhang, Fan Xu, Jingcheng Cao, Qingqing Dou, Juan Wang, Jing Wang, Lei Yang, Wei Chen
Journal: Bioactive Materials (2023)

The bone fracture cases have been increasing yearly, accompanied by the increased number of patients experiencing non-union or delayed union after their bone fracture. Although clinical materials facilitate fracture healing (e.g., metallic and composite materials), they cannot fulfill the requirements due to the slow degradation rate, limited osteogenic activity, inadequate osseointegration ability, and suboptimal mechanical properties. Since early 2000, nanomaterials successfully mimic the nanoscale features of bones and offer unique properties, receiving extensive attention. This paper reviews the achievements of nanomaterials in treating bone fracture (e.g., the intrinsic properties of nanomaterials, nanomaterials for bone defect filling, and nanoscale drug delivery systems in treating fracture delayed union). Furthermore, we discuss the perspectives on the challenges and future directions of developing nanomaterials to accelerate fracture healing.
Safety of Switching from a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients with Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial
Authors: Linda P.T. Joosten, Sander van Doorn, Peter M. van de Ven, Bart T.G. Köhlen, Melchior C. Nierman, Huiberdina L. Koek, Martin E.W. Hemels, Menno V. Huisman, Marieke Kruip, Laura M. Faber, Nynke M. Wiersma, Wim F. Buding, Rob Fijnheer, Henk J. Adriaansen, Kit C. Roes, Arno W. Hoes, Frans H. Rutten, Geert-Jan Geersing
Journal: Circulation (2023)

There is ambiguity whether frail patients with atrial fibrillation managed with vitamin K antagonists (VKAs) should be switched to a non-vitamin K oral anticoagulant (NOAC). We conducted a pragmatic, multicenter, open-label, randomized controlled superiority trial. Older patients with atrial fibrillation living with frailty (≥75 years of age plus a Groningen Frailty Indicator score ≥3) were randomly assigned to switch from international normalized ratio-guided VKA treatment to an NOAC or to continued VKA treatment. Patients with a glomerular filtration rate <30 mL·min-1·1.73 m-2 or with valvular atrial fibrillation were excluded. Follow-up was 12 months. The cause-specific hazard ratio was calculated for occurrence of the primary outcome that was a major or clinically relevant nonmajor bleeding complication, whichever came first, accounting for death as a competing risk. Analyses followed the intention-to-treat principle. Secondary outcomes included thromboembolic events. Between January 2018 and June 2022, a total of 2621 patients were screened for eligibility and 1330 patients were randomly assigned (mean age 83 years, median Groningen Frailty Indicator score 4). After randomization, 6 patients in the switch-to-NOAC arm and 1 patient in the continue-with-VKA arm were excluded due to the presence of exclusion criteria, leaving 662 patients switched from a VKA to an NOAC and 661 patients continued VKAs in the intention-to-treat population. After 163 primary outcome events (101 in the switch arm, 62 in the continue arm), the trial was stopped for futility according to a prespecified futility analysis. The hazard ratio for our primary outcome was 1.69 (95% CI, 1.23-2.32). The hazard ratio for thromboembolic events was 1.26 (95% CI, 0.60-2.61). Switching international normalized ratio-guided VKA treatment to an NOAC in frail older patients with atrial fibrillation was associated with more bleeding complications compared with continuing VKA treatment, without an associated reduction in thromboembolic complications. URL: https://eudract.ema.europa.eu; Unique identifier: 2017-000393-11. URL: https://eudract.ema.europa.eu; Unique identifier: 6721 (FRAIL-AF study).
OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions
Authors: Niels R. Holm, Lene N. Andreasen, Omeed Neghabat, Peep Laanmets, Indulis Kumsars, Johan Bennett, Niels T. Olsen, Jacob Odenstedt, Pavel Hoffmann, Jo Dens, Saqib Chowdhary, Peter O’Kane, Søren-Haldur Bülow Rasmussen, Matthias Heigert, Ole Havndrup, Jan P. Van Kuijk, Simone Biscaglia, Lone J.H. Mogensen, Loghman Henareh, Francesco Burzotta, Christian H. Eek, Darren Mylotte, Miquel S. Llinas, Lukasz Koltowski, Paul Knaapen, Slobodan Calic, Nils Witt, Irene Santos-Pardo, Stuart Watkins, Jacob Lønborg, Andreas T. Kristensen, Lisette O. Jensen, Fredrik Calais, James Cockburn, Andrew McNeice, Olli A. Kajander, Ton Heestermans, Stephan Kische, Ashkan Eftekhari, James C. Spratt, Evald H. Christiansen
Journal: New England Journal of Medicine (2023)

Imaging-guided percutaneous coronary intervention (PCI) is associated with better clinical outcomes than angiography-guided PCI. Whether routine optical coherence tomography (OCT) guidance in PCI of lesions involving coronary-artery branch points (bifurcations) improves clinical outcomes as compared with angiographic guidance is uncertain. Download a PDF of the Research Summary. We conducted a multicenter, randomized, open-label trial at 38 centers in Europe. Patients with a clinical indication for PCI and a complex bifurcation lesion identified by means of coronary angiography were randomly assigned in a 1:1 ratio to OCT-guided PCI or angiography-guided PCI. The primary end point was a composite of major adverse cardiac events (MACE), defined as death from a cardiac cause, target-lesion myocardial infarction, or ischemia-driven target-lesion revascularization at a median follow-up of 2 years. We assigned 1201 patients to OCT-guided PCI (600 patients) or angiography-guided PCI (601 patients). A total of 111 patients (18.5%) in the OCT-guided PCI group and 116 (19.3%) in the angiography-guided PCI group had a bifurcation lesion involving the left main coronary artery. At 2 years, a primary end-point event had occurred in 59 patients (10.1%) in the OCT-guided PCI group and in 83 patients (14.1%) in the angiography-guided PCI group (hazard ratio, 0.70; 95% confidence interval, 0.50 to 0.98; P=0.035). Procedure-related complications occurred in 41 patients (6.8%) in the OCT-guided PCI group and 34 patients (5.7%) in the angiography-guided PCI group. Among patients with complex coronary-artery bifurcation lesions, OCT-guided PCI was associated with a lower incidence of MACE at 2 years than angiography-guided PCI. (Funded by Abbott Vascular and others; OCTOBER ClinicalTrials.gov number, NCT03171311.) QUICK TAKE VIDEO SUMMARYOCT-Guided PCI in Complex Bifurcation Lesions 02:05
Interaction pathways of implant metal localized corrosion and macrophage inflammatory reactions
Authors: Meng Li, Jing Wu, Wenbo Geng, Pengfei Gao, Yulu Yang, Xuan Li, Kun Xu, Qiang Liao, Kaiyong Cai
Journal: Bioactive Materials (2023)

Macrophages play a central role in immunological responses to metallic species associated with the localized corrosion of metallic implants, and mediating in peri-implant inflammations. Herein, the pathways of localized corrosion-macrophage interactions were systematically investigated on 316L stainless steel (SS) implant metals. Electrochemical monitoring under macrophage-mediated inflammatory conditions showed a decreased pitting corrosion resistance of 316L SSs in the presence of RAW264.7 cells as the cells would disrupt biomolecule adsorbed layer on the metal surface. The pitting potentials were furtherly decreased when the RAW264.7 cells were induced to the M1 pro-inflammatory phenotype by the addition of lipopolysaccharide (LPS), and pitting corrosion preferentially initiated at the peripheries of macrophages. The overproduction of aggressive ROS under inflammatory conditions would accelerate the localized corrosion of 316L SS around macrophages. Under pitting corrosion condition, the viability and pro-inflammatory polarization of RAW264.7 cells were region-dependent, lower viability and more remarkable morphology transformation of macrophages in the pitting corrosion region than the pitting-free region. The pitting corrosion of 316L SS induced high expression of CD86, TNF-α, IL-6 and high level of intracellular ROS in macrophages. Uneven release of metallic species (Fe2+, Cr3+, Ni2+, etc) and uneven distribution of surface overpotential stimulated macrophage inflammatory responses near the corrosion pits. A synergetic effect of localized corrosion and macrophages was revealed, which could furtherly promote localized corrosion of 316L SS and macrophage inflammatory reactions. Our results provided direct evidence of corrosion-macrophage interaction in metallic implants and disclosed the pathways of this mutual stimulation effect.
Catheter Ablation in End-Stage Heart Failure with Atrial Fibrillation
Authors: Christian Sohns, Henrik Fox, Nassir F. Marrouche, Harry J.G.M. Crijns, Angelika Costard-Jaeckle, Leonard Bergau, Gerhard Hindricks, Nikolaos Dagres, Samuel Sossalla, Rene Schramm, Thomas Fink, Mustapha El Hamriti, Maximilian Moersdorf, Vanessa Sciacca, Frank Konietschke, Volker Rudolph, Jan Gummert, Jan G.P. Tijssen, Philipp Sommer
Journal: New England Journal of Medicine (2023)

The role of catheter ablation in patients with symptomatic atrial fibrillation and end-stage heart failure is unknown. Download a PDF of the Research Summary. We conducted a single-center, open-label trial in Germany that involved patients with symptomatic atrial fibrillation and end-stage heart failure who were referred for heart transplantation evaluation. Patients were assigned to receive catheter ablation and guideline-directed medical therapy or medical therapy alone. The primary end point was a composite of death from any cause, implantation of a left ventricular assist device, or urgent heart transplantation. A total of 97 patients were assigned to the ablation group and 97 to the medical-therapy group. The trial was stopped for efficacy by the data and safety monitoring board 1 year after randomization was completed. Catheter ablation was performed in 81 of 97 patients (84%) in the ablation group and in 16 of 97 patients (16%) in the medical-therapy group. After a median follow-up of 18.0 months (interquartile range, 14.6 to 22.6), a primary end-point event had occurred in 8 patients (8%) in the ablation group and in 29 patients (30%) in the medical-therapy group (hazard ratio, 0.24; 95% confidence interval [CI], 0.11 to 0.52; P<0.001). Death from any cause occurred in 6 patients (6%) in the ablation group and in 19 patients (20%) in the medical-therapy group (hazard ratio, 0.29; 95% CI, 0.12 to 0.72). Procedure-related complications occurred in 3 patients in the ablation group and in 1 patient in the medical-therapy group. Among patients with atrial fibrillation and end-stage heart failure, the combination of catheter ablation and guideline-directed medical therapy was associated with a lower likelihood of a composite of death from any cause, implantation of a left ventricular assist device, or urgent heart transplantation than medical therapy alone. (Funded by Else Kröner-Fresenius-Stiftung; CASTLE-HTx ClinicalTrials.gov number, NCT04649801.) QUICK TAKE VIDEO SUMMARYCatheter Ablation for Advanced Heart Failure and AFib 01:59
Improving measurement of tuberculosis care cascades to enhance people-centred care
Authors: Lena Faust, Pren Naidoo, Guillermo Caceres-Cardenas, César Ugarte-Gil, Monde Muyoyeta, Andrew D Kerkhoff, Karikalan Nagarajan, Srinath Satyanarayana, Niaina Rakotosamimanana, Simon Grandjean Lapierre, Olusola Adedeji Adejumo, Joseph Kuye, Charity Oga-Omenka, Madhukar Pai, Ramnath Subbaraman
Journal: The Lancet Infectious Diseases (2023)
Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction
Authors: Simone Biscaglia, Vincenzo Guiducci, Javier Escaned, Raul Moreno, Valerio Lanzilotti, Andrea Santarelli, Enrico Cerrato, Giorgio Sacchetta, Alfonso Jurado-Roman, Alberto Menozzi, Ignacio Amat Santos, José Luis Díez Gil, Marco Ruozzi, Marco Barbierato, Luca Fileti, Andrea Picchi, Veronica Lodolini, Giuseppe Biondi-Zoccai, Elisa Maietti, Rita Pavasini, Paolo Cimaglia, Carlo Tumscitz, Andrea Erriquez, Carlo Penzo, Iginio Colaiori, Gianluca Pignatelli, Gianni Casella, Gianmarco Iannopollo, Mila Menozzi, Ferdinando Varbella, Giorgio Caretta, Dariusz Dudek, Emanuele Barbato, Matteo Tebaldi, Gianluca Campo
Journal: New England Journal of Medicine (2023)

The benefit of complete revascularization in older patients (≥75 years of age) with myocardial infarction and multivessel disease remains unclear.In this multicenter, randomized trial, we assigned older patients with myocardial infarction and multivessel disease who were undergoing percutaneous coronary intervention (PCI) of the culprit lesion to receive either physiology-guided complete revascularization of nonculprit lesions or to receive no further revascularization. Functionally significant nonculprit lesions were identified either by pressure wire or angiography. The primary outcome was a composite of death, myocardial infarction, stroke, or any revascularization at 1 year. The key secondary outcome was a composite of cardiovascular death or myocardial infarction. Safety was assessed as a composite of contrast-associated acute kidney injury, stroke, or bleeding.A total of 1445 patients underwent randomization (720 to receive complete revascularization and 725 to receive culprit-only revascularization). The median age of the patients was 80 years (interquartile range, 77 to 84); 528 patients (36.5%) were women, and 509 (35.2%) were admitted for ST-segment elevation myocardial infarction. A primary-outcome event occurred in 113 patients (15.7%) in the complete-revascularization group and in 152 patients (21.0%) in the culprit-only group (hazard ratio, 0.73; 95% confidence interval [CI], 0.57 to 0.93; P = 0.01). Cardiovascular death or myocardial infarction occurred in 64 patients (8.9%) in the complete-revascularization group and in 98 patients (13.5%) in the culprit-only group (hazard ratio, 0.64; 95% CI, 0.47 to 0.88). The safety outcome did not appear to differ between the groups (22.5% vs. 20.4%; P = 0.37).Among patients who were 75 years of age or older with myocardial infarction and multivessel disease, those who underwent physiology-guided complete revascularization had a lower risk of a composite of death, myocardial infarction, stroke, or ischemia-driven revascularization at 1 year than those who received culprit-lesion-only PCI. (Funded by Consorzio Futuro in Ricerca and others; FIRE ClinicalTrials.gov number, NCT03772743.).
Complete Revascularization in Older Patients with Myocardial Infarction
Authors: Shamir R. Mehta
Journal: New England Journal of Medicine (2023)

Older adults with acute MI are a growing population with unique treatment challenges. Shamir Mehta comments on the findings of the FIRE trial comparing complete revascularization with culprit-lesion–only PCI in adults ≥75 years of age.
Extracorporeal Life Support in Infarct-Related Cardiogenic Shock
Authors: Holger Thiele, Uwe Zeymer, Ibrahim Akin, Michael Behnes, Tienush Rassaf, Amir Abbas Mahabadi, Ralf Lehmann, Ingo Eitel, Tobias Graf, Tim Seidler, Andreas Schuster, Carsten Skurk, Daniel Duerschmied, Peter Clemmensen, Marcus Hennersdorf, Stephan Fichtlscherer, Ingo Voigt, Melchior Seyfarth, Stefan John, Sebastian Ewen, Axel Linke, Eike Tigges, Peter Nordbeck, Leonhard Bruch, Christian Jung, Jutta Franz, Philipp Lauten, Tomaz Goslar, Hans-Josef Feistritzer, Janine Pöss, Eva Kirchhof, Taoufik Ouarrak, Steffen Schneider, Steffen Desch, Anne Freund
Journal: New England Journal of Medicine (2023)

Extracorporeal life support (ECLS) is increasingly used in the treatment of infarct-related cardiogenic shock despite a lack of evidence regarding its effect on mortality. Download a PDF of the Research Summary. In this multicenter trial, patients with acute myocardial infarction complicated by cardiogenic shock for whom early revascularization was planned were randomly assigned to receive early ECLS plus usual medical treatment (ECLS group) or usual medical treatment alone (control group). The primary outcome was death from any cause at 30 days. Safety outcomes included bleeding, stroke, and peripheral vascular complications warranting interventional or surgical therapy. A total of 420 patients underwent randomization, and 417 patients were included in final analyses. At 30 days, death from any cause had occurred in 100 of 209 patients (47.8%) in the ECLS group and in 102 of 208 patients (49.0%) in the control group (relative risk, 0.98; 95% confidence interval [CI], 0.80 to 1.19; P=0.81). The median duration of mechanical ventilation was 7 days (interquartile range, 4 to 12) in the ECLS group and 5 days (interquartile range, 3 to 9) in the control group (median difference, 1 day; 95% CI, 0 to 2). The safety outcome consisting of moderate or severe bleeding occurred in 23.4% of the patients in the ECLS group and in 9.6% of those in the control group (relative risk, 2.44; 95% CI, 1.50 to 3.95); peripheral vascular complications warranting intervention occurred in 11.0% and 3.8%, respectively (relative risk, 2.86; 95% CI, 1.31 to 6.25). In patients with acute myocardial infarction complicated by cardiogenic shock with planned early revascularization, the risk of death from any cause at the 30-day follow-up was not lower among the patients who received ECLS therapy than among those who received medical therapy alone. (Funded by the Else Kröner Fresenius Foundation and others; ECLS-SHOCK ClinicalTrials.gov number, NCT03637205.) QUICK TAKE VIDEO SUMMARYExtracorporeal Life Support in Cardiogenic Shock 01:56
Separating Actionable From Incidental Findings—Imperative for Meaningful Clinical Outcomes—Reply
Authors: Ilana F. Gareen, Richard M. Hoffman, Tina D. Tailor
Journal: JAMA Internal Medicine (2023)

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